The Evolution of Competency Based Training in Healthcare

How can we prove that the training provided by to healthcare clinicians is improving patient outcomes? The answer comes with competency based training - learning from the perspective of the clinician. LIke any popular methodology, there are a broad number of pieces to the definition. Some are as dry and devoid of creativity as you would imagine. Other more recent definitions, however, take advantage of the adult learning trends that have been evolving in the training world and incorporate them into CBT. The one we are going to go over, is Andragogy.

The Evolution of Andragogy to Compentency Based Training

In 1968, Malcolm Knowles introduced the concept of Andragogy, because he understood that working adults are busy professionals, who are motivated to learn in different ways. The tenets of Andragogy are simple - adults are self-empowered beings who are motivated to learn in the process of problem solving. In 1973 Malcolm Knowles released a publication titled, The Adult Learner: A Neglected Species. In this publication he outlined how adults are self-directed and want to be responsible for the outcome of applying learning to real problems. We inherently learn through the application of knowledge and evaluation of results - also known as trial and error. The hectic lifestyle of business professionals cause them to favour “just-in-time” learning solutions - they want to learn only what they need, when they need, so that they can apply it to the problem at hand and achieve results right away. The sum of their learning comes in chunks or modules that eventually form into an aggregated competency.

Based on the foundational principles of andragogy, competency based learning embraces the idea that effective learning is learning that is applied to real problems. Instead of focusing on high level abstract concepts and frameworks that can be applied across multiple job contexts, the Competency Based Learning approach encourages teachers to take a very specific set of job related output requirements - discrete competencies - and create measurable situations where knowledge can be applied and measured to determine if an outcome has been reached.

The instructor acts more like a facilitator than a presenter. Instead of telling an individual what to do in the situation, they provide upfront guidance around how to think about and approach the task at hand. Followed by this, the facilitator then encourages learners to create their own path through the problem in front of them - a path that creates “Artifacts” that act as evidence that the learning has been correctly applied, This leads to a greater sense of confidence in the efficacy of the learning where confidence is extended to the idea that this application can be replicated to the next problem, and result in another successful outcome.

For example, in an article published by the Association of Talent Development (more commonly known as ATD) titled “Smart Jobs, Smart People”, Jonathon Levy notes “what is required is real-time learning: learning how to do a job while you are actually doing it, and then upgrading your skills while you are mastering the skills you just learned.” While Levy takes this to a visionary place where performance support is available every step of the way, the tenets are real today. CBT can be structured as the foundation of a learning culture that trains you on what you need to learn (input) at the time you are undertaking the new challenge to produce desired outcomes (output) - again drawing back to the idea of Just-in-time competency training.

In fact, the biggest challenge to healthcare is to create cultures that embrace the competency based training approach. Healthcare needs to overcome the vocational training stigma that comes with an approach focused solely on discrete output. While it will take time to change the culture of learning in healthcare,healthcare, what follows is a discussion of CBT benefits that will help sway decision makers to take steps forward to make this change.